Acute Pancreatitis

Pancreatitis is the inflammation of the pancreas. The pancreas is an organ anatomically located just underneath our stomach which helps to digest food and also secretes hormones. Among the important hormones secreted are insulin and glucagon which helps to regulate our blood sugar.

Pancreatitis can be divided into acute or chronic pancreatitis depending on the duration and onset of the inflammation.

Patients with Acute Pancreatitis usually present with severe upper abdominal pain which radiates to the back, nausea & vomiting with a history of gallstones or alcohol bingeing. The causes of acute pancreatitis include:
- gallstones
- alcohol ingestion
- trauma (blunt or penetrating) to the abdomen
- post abdominal surgery or ERCP (endoscopic retrograde cholangiopancreaticogram)
- pancreatic tumours or structural abnormalities
- medications such as corticosteroids, diuretics, ACE inhibitors
- autoimmune pancreatitis
- viral infection such as mumps
- high calcium levels
- high fat (triglyceride) levels

Investigations for patients with Acute Pancreatitis include:
- raised serum amylase (usually taken as >4 times normal lab value)
- raised serum lipase
- raised urinary amylase
- raised C-reactive protein
- radiological investigations such as ultrasound or CT scan to look for gallstones or other abnormalities

Patients who are diagnosed with Acute Pancreatitis will need to be admitted into the hospital for close observation. This is because the disease might worsen and lead to severe sepsis and multi-organ failure. The severity of the disease is classified according to the Imrie-Glasgow, Ranson or APACHE II criterias.
Patients are usually kept fasted to reduce the pancreatic function and started on intravenous fluids and also analgesics. They are also given supplemental oxygen.
Patients who have Acute Pancreatitis due to gallstones will need a cholecystectomy (surgical removal of the gallbladder) to avoid further recurrence of the disease.
Patients who are chronic alcoholics should be referred for counselling and also taught coping strategies and encouraged to join Alcoholic Anonymous and other support networks.

The sequelae of Acute Pancreatits include:
- complete recovery (majority of patients)
- destruction and infection of part of the pancreas (necrosis)
- acute fluid collection around the pancreas
- pancreatic pseudocyst (collection of fluid around the pancreas seen >4 weeks after the initial diagnosis)
- pancreatic abscess